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1.
Eur Rev Med Pharmacol Sci ; 22(2): 372-381, 2018 01.
Artículo en Inglés | MEDLINE | ID: mdl-29424893

RESUMEN

Transarterial therapies in the setting of primary and secondary liver malignancies are becoming an essential part of the oncology landscape. The mechanism of action of c-TACE is the induction of tumor necrosis due to the high concentration of the chemotherapeutic that is delivered only locally and to the embolic effect that causes ischemia and increased dwell time of the chemotherapeutic in the tumor. Recently, DEB-TACE has emerged as a variation of c-TACE with the potential for the selective delivery of large amounts of drugs to the tumor for a prolonged period, thereby decreasing plasma levels of the chemotherapeutic agent and related systemic effects. There is an increasing consensus that compared with conventional lipiodol-based regimen, DEB-TACE offers standardized methodology, is more reproducible and is associated with improved response and significantly better safety profile. Using an easy to access point by point format, this manuscript summarizes the expert discussion from the Mediterranean Interventional Oncology Live Congress (MIOLive 2017) about the role of TACE in the treatment of liver tumors.


Asunto(s)
Carcinoma Hepatocelular/terapia , Quimioembolización Terapéutica , Neoplasias Hepáticas/terapia , Carcinoma Hepatocelular/patología , Quimioembolización Terapéutica/efectos adversos , Congresos como Asunto , Aceite Etiodizado/química , Humanos , Neoplasias Hepáticas/patología , Recurrencia Local de Neoplasia , Selección de Paciente
2.
Epilepsy Res ; 87(2-3): 290-8, 2009 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-19879110

RESUMEN

PURPOSE: To try to prove in patients with refractory symptomatic epilepsy due to early brain injury involving thalamus and complicated by CSWS the effects of the isolation of the injured hemisphere, performed with functional hemisperectomy, on epilepsy, namely on CSWS. METHODS: Full clinical follow-up before and after surgery of two cases with CSWS onset at four years in whom functional hemispherecomy was performed with resection of inter-hemispheric connections. RESULTS: An immediate effectiveness of the surgical treatment was observed on both epileptic evolution (no more seizures) and EEG abnormalities. In particular, CSWS completely disappeared, together with a concurrent progressive improving of the cognitive and behavioural disorders. DISCUSSION: The isolation of the injured hemisphere through the section of inter-hemispheric cortico-cortical connections could prevent the contralateral diffusion of discharges coming from the injured cortex and cortico-thalamic network, favouring a normal function of thalamo-cortico-thalamic circuitries in the healthy hemisphere. That could explain the disappearance of CSWS after surgery in our patients and the consequent improvement of cognitive abilities and behaviour.


Asunto(s)
Lesiones Encefálicas/complicaciones , Epilepsias Parciales/cirugía , Trastornos del Sueño-Vigilia/cirugía , Tálamo/lesiones , Edad de Inicio , Lesiones Encefálicas/fisiopatología , Lesiones Encefálicas/cirugía , Corteza Cerebral/fisiopatología , Corteza Cerebral/cirugía , Niño , Preescolar , Trastornos del Conocimiento/complicaciones , Trastornos del Conocimiento/fisiopatología , Trastornos del Conocimiento/cirugía , Progresión de la Enfermedad , Supervivencia sin Enfermedad , Electroencefalografía , Epilepsias Parciales/complicaciones , Epilepsias Parciales/fisiopatología , Femenino , Hemisferectomía , Humanos , Imagen por Resonancia Magnética , Pruebas Neuropsicológicas , Calidad de Vida , Trastornos del Sueño-Vigilia/complicaciones , Trastornos del Sueño-Vigilia/fisiopatología , Encuestas y Cuestionarios , Tálamo/fisiopatología , Tálamo/cirugía , Resultado del Tratamiento
3.
Radiol Med ; 114(7): 1141-58, 2009 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-19774443

RESUMEN

PURPOSE: Percutaneous vertebroplasty (PVP) is a minimally invasive treatment for symptomatic vertebral compression fractures (VCFs). The aim of this study was to assess the effectiveness, complications and progress of results of PVP optimized in terms of technique, costs, time and strategic protocol after 3 years of procedures performed under fluoroscopic guidance alone. MATERIALS AND METHODS: We treated 250 VCFs in 120 consecutive patients after assessing clinical and radiological indications. The effectiveness of the procedure was determined by statistical analysis of numerical scores for pain, mobility and drug consumption before and after treatment. RESULTS: No major complications and only three minor complications occurred. Clinically relevant improved mobility and reduction of pain and analgesics were observed, with overall significant results (p<0.0001) in all patients at 24 h after PVP and in 83 available patients at 6 months. A total of five asymptomatic refractures of cemented vertebrae and 14 new symptomatic vertebral fractures at different levels were observed between 1 and 10 months after the procedure. CONCLUSIONS: PVP is a safe, rapid, effective and costeffective therapy for VCFs, requiring only brief hospital admission and with long-lasting clinical results, when performed under good-quality radiological guidance, when correct indications are respected and when it is associated with rehabilitation therapy in the follow-up. It is a valid alternative to conservative therapy, which is burdened by high healthcare costs and often requires long-term immobilisation of frail and elderly patients at risk of clinical complications.


Asunto(s)
Fracturas por Compresión/diagnóstico por imagen , Fracturas por Compresión/cirugía , Fotofluorografía , Radiografía Intervencional , Fracturas de la Columna Vertebral/diagnóstico por imagen , Fracturas de la Columna Vertebral/cirugía , Vertebroplastia/métodos , Anciano , Anciano de 80 o más Años , Cementos para Huesos/uso terapéutico , Femenino , Fijación Interna de Fracturas/métodos , Fracturas por Compresión/etiología , Fracturas por Compresión/terapia , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Ortopédicos/métodos , Osteoporosis/complicaciones , Dimensión del Dolor/métodos , Fotofluorografía/métodos , Calidad de Vida , Reoperación , Estudios Retrospectivos , Medición de Riesgo , Fracturas de la Columna Vertebral/etiología , Fracturas de la Columna Vertebral/rehabilitación , Fusión Vertebral/métodos , Neoplasias de la Columna Vertebral/complicaciones , Columna Vertebral/diagnóstico por imagen , Columna Vertebral/cirugía , Resultado del Tratamiento
4.
J Neurol Neurosurg Psychiatry ; 78(8): 877-9, 2007 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-17578856

RESUMEN

Prior coffee and smoking habits were investigated in a multicentre case control study involving 166 patients presenting with primary late onset blepharospasm (BSP), 228 hospital control patients with primary hemifacial spasm and 187 population control subjects from five Italian centres. Information on age at disease onset, smoking and coffee drinking status at the reference age and average number of cups of coffee drunk/cigarettes smoked per day reached high and similar test-retest reproducibility in case and control patients. Unadjusted logistic regression analysis yielded a significant inverse association of prior coffee drinking and cigarette smoking with case status for the control groups. After adjustment for age, sex, referral centre, disease duration, years of schooling and ever coffee drinking/cigarette smoking, as appropriate, the smoking estimate lacked significance whereas the association of coffee intake and BSP did not (cases vs hospital control patients: OR 0.37 (95% CI 0.20 to 0.67); cases vs population control subjects: OR 0.44 (95% CI 0.23 to 0.85)). The strength of the inverse association between BSP and coffee intake tended to increase with the average number of cups drunk per day. There was a significant correlation between age of BSP onset and number of cups per day (adjusted regression coefficient 1.73; p = 0.001) whereas no correlation was found with number of packs of cigarettes per day. Coffee drinking may be inversely associated with the development of primary BSP and this association may partly depend on the amount consumed.


Asunto(s)
Blefaroespasmo/epidemiología , Café , Fumar/efectos adversos , Edad de Inicio , Anciano , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Factores de Riesgo
5.
Clin Neurophysiol ; 113(11): 1673-9, 2002 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-12417219

RESUMEN

OBJECTIVE: The motor evoked potential to a single suprathreshold transcranial magnetic stimulus (TMS) is suppressed by a preceding stimulus given 100-200 ms before (long latency intracortical inhibition, LICI). The effect is enhanced in patients with Parkinson's disease. Although previous studies have agreed that the effect is cortical, there is disagreement over exactly which cortical mechanisms are involved. The aim of this study was to provide further evidence for cortical involvement in LICI. METHODS: Recordings of corticospinal volleys evoked by the TMS stimulation were made from electrodes inserted into the cervical epidural space of 4 conscious subjects. Three of the patients had received the electrodes for treatment of lumbo-sacral pain; the other patient had vascular parkinsonism, and had the electrode implanted to evaluate its effect on cerebral blood flow. The number and amplitude of the volleys were compared with and without a conditioning stimulus. RESULTS: In 3 pain patients, a conditioning stimulus suppressed the later components of the corticospinal volley (I2 and later waves) when the interval between stimuli was 100-150 ms; at 50 ms the responses were enhanced. Early components of the volley were not affected. Inhibition was much more pronounced and involved all descending volleys except the D wave in the patient with vascular parkinsonism. CONCLUSIONS: LICI, which is conventionally described in EMG recordings, is also evident in recordings of descending corticospinal volleys and appears enhanced in a patient with vascular parkinsonism.


Asunto(s)
Trastornos Cerebrovasculares/fisiopatología , Potenciales Evocados Motores/fisiología , Corteza Motora/fisiopatología , Enfermedad de Parkinson/fisiopatología , Dolor de Espalda/fisiopatología , Circulación Cerebrovascular/fisiología , Trastornos Cerebrovasculares/patología , Electrodos Implantados , Campos Electromagnéticos , Espacio Epidural , Femenino , Lateralidad Funcional/fisiología , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Corteza Motora/patología , Vías Nerviosas/fisiopatología , Enfermedad de Parkinson/patología , Médula Espinal/fisiopatología , Estimulación Eléctrica Transcutánea del Nervio
6.
Acta Neurochir (Wien) ; 140(5): 447-54, 1998.
Artículo en Inglés | MEDLINE | ID: mdl-9728244

RESUMEN

Although histologically benign, craniopharyngioma can regrow either from macroscopic remnants of the tumour left behind at operation, or even after an apparently gross total removal. Recurrence rates vary significantly in the literature, depending on the efficacy of surgical treatment and also on the growth potential of the tumour itself. The main factor influencing tumour regrowth is obviously the extent of surgical resection, as total removal carries a much lesser risk of recurrence compared to subtotal or partial resections (although in such cases radiation therapy can lower this risk significantly). Other factors involved are the duration of follow-up and patient's age at operation, as children tend to relapse more frequently than adults. Even in the "microsurgery" era, characterized by high percentages of total resections, recurrences remain high and continue to represent a major problem of craniopharyngioma treatment. Twenty-seven children and adolescents were operated on for craniopharyngioma at the Department of Neurosurgery, Section of Pediatric Neurosurgery, Catholic University Medical School, Rome between June 1985 and June 1997. Total tumour resection was achieved in 18 cases, subtotal in 7 and partial in 2 instances. One patient died post-operatively. Post-operative neuroradiological investigations confirmed the operative findings, although 3 children with an apparently gross total removal showed a residual non-enhancing calcium fleck adherent to the hypothalamus (which remained stable at the following examinations). Three of the 9 patients with less than total removal underwent post-operative radiation therapy. Out of the 26 surviving patients 6 presented a recurrence of their craniopharyngioma, 2 after an apparently gross total removal and 4 after a subtotal or partial resection (one of them had received radiation therapy). The diagnosis was merely neuroradiological in 5 cases, as only one child presented a clinical picture suggestive of tumour regrowth. Surgery was the first therapeutic option in all the cases. Total tumour resection was accomplished in 3 cases, subtotal in 2 and partial in the last one. One child died post-operatively. Four of the 5 survivors received radiation therapy. All the patients are presently alive and stable (mean follow-up: 5.6 yrs). The authors conclude that surgery should be the first therapeutic option in case of recurrent craniopharyngioma and that radiation therapy should also be considered but only as adjuvant therapy.


Asunto(s)
Craneofaringioma/cirugía , Recurrencia Local de Neoplasia/prevención & control , Adolescente , Niño , Preescolar , Terapia Combinada , Craneofaringioma/diagnóstico , Craneofaringioma/radioterapia , Femenino , Estudios de Seguimiento , Humanos , Lactante , Imagen por Resonancia Magnética , Masculino , Recurrencia Local de Neoplasia/radioterapia , Recurrencia Local de Neoplasia/cirugía , Neoplasia Residual , Selección de Paciente , Neoplasias Hipofisarias/diagnóstico , Neoplasias Hipofisarias/radioterapia , Neoplasias Hipofisarias/cirugía , Complicaciones Posoperatorias , Radioterapia Adyuvante , Reoperación/métodos , Factores de Tiempo , Resultado del Tratamiento
7.
Psychiatr Med ; 10(1): 149-67, 1992.
Artículo en Inglés | MEDLINE | ID: mdl-1549749

RESUMEN

This chapter will describe the use of clinical hypnosis in the military. As a result of the studies that were done during the Vietnam conflict, the relationship between post traumatic stress disorder and hypnotize ability was made. The author concludes that combat traumas enhance hypnotic potential in some veterans, and that veterans with excellent hypnotic potential begin to problem solve better preparing for a healthier post-war transition.


Asunto(s)
Hipnosis/métodos , Personal Militar , Trastornos de Combate/terapia , Femenino , Hospitales Militares , Humanos , Capacitación en Servicio , Acontecimientos que Cambian la Vida , Masculino , Personal de Hospital/educación , Estados Unidos
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